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Clinical Bioethics

GiordanoWe have come to recognize pain as both a physiological event of the nervous system and as an emergent psychological phenomenon of consciousness.1,2 As such, while the objective properties of the sensation of pain may be quantifiable, the qualitative dimensions of the experience of pain are individually variable and, in many ways, are unique to the person who suffers—reflective of the ongoing interaction of hereditary and environmental interactions throughout the lifespan that are both pre-dispositional to, and affected by pain (and its broadly bio-psychosocial manifestations). The event of pain is inextricable from the event of consciousness.2,3 As conscious process, it manifests subjectivity and transparency (only) to self.

This first-person experience of the subjective “self” is grounded in personal circumstance, and bounded by place and time. But what is this “self”? Polymath Douglas Hofstadter claims that “…an ‘I’ is an abstract pattern that arises naturally …in human brains.”4 To be sure, as I have previously noted, our ‘selves’ arise from our brains, and our brains are nested within, and are the stuff of our universe.5 Yet, try as we might, attempts to reduce consciousness and/or self-consciousness to the mechanisms of interacting molecules or even atoms have failed (at least to date). It may well be, as Hofstader states, that “…life resides on a level …that no being could survive if it concentrated on that level.”6 Hence, the experiences of body, brain, and world are essential to the self, and these experiences assume meaning based upon circumstance(s) and manifestation(s). Our “self” is what Damasio has called “the feeling of what happens,”7 not simply on a sensory level, but on levels of cerebral function that involve concomitant temporal and intentional interpretation, as relevant to each person’s history and anticipations of the future.8 Thus, it is this abstract “self” that allows metarepresentations of what we are, allows interactions with others, and becomes the basis of interacting with the world at large.

Pain, the “Self” and Spirituality
Given that the physical process of pain can affect the brain substrates of consciousness, and thereby affect this “self,” we may view pain as an phenomenal event that can “trap” the person within a lived body—to which they have become dis-attuned—and limit the capacity for other experiences of the inner and outer environment that constitute each person’s life world.8,9 In this way, the existential reality of pain can be both an intrinsic part of the person, and a way of being in the world. It becomes a part of the self, may define the self, and can become something greater than the self.

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Last updated on: February 22, 2011
First published on: April 1, 2007